Why both sides want to play political football with the NHS

Richard Sloggett

Senior Fellow and Health and Social Care Lead (2019-2020)

Hospital and doctors’ leaders have intervened in the election campaign to call for an evidence based debate on the NHS issues that really matter rather than slogans, jibes and spin. Their calls are unfortunately likely to fall on deaf ears.

Analysis for Policy Exchange of the public Ipsos Mori Issues Index reveals the importance of the NHS in deciding general elections. A look back through the last six elections (1997-2017) at the role of the NHS in determining the outcome sees three trends emerge:

Both parties think they can win on the NHS
The NHS has been the number one issue of importance for voters in five of the last six campaigns (the exception was 2010 when the issue was fourth). Contrary to perception the Conservatives can win an election in these circumstances: in 2015 the party won an overall parliamentary majority with the NHS as the most often cited important issue by voters (47 per cent).

Labour has never won an election over the time period when the NHS has been cited as important by fewer than 40 per cent of voters. Perhaps surprisingly the current Ipsos Mori Issues Tracker from August to September has the NHS down 5 points in importance from 41 per cent to 36 per cent. There is therefore some interest in both parties talking up their NHS credentials in the campaign.

If NHS importance rises too much, it hurts Conservative governments
Conservative governments lose parliamentary seats when the NHS is important to over 60 per cent of voters, as happened in 1997 and 2017.

The importance of the NHS was cited by 14 per cent more voters during the election campaign in 2017 than 2015. Labour increased its overall vote share by twice as much as the Tories over the time period.

Labour believes that the NHS can help build their election campaign momentum
In the run-up to polling day there has been on average a 7 per cent increase in voters stating that the NHS is an important issue. Only in the 2010 election campaign did the importance of the NHS fall as an issue during the two months building up to the campaign (-2 per cent, March 2010-April 2010).

In two elections, 2017 and 1997, the salience of the NHS increased by 13 per cent and 14 per cent respectively in the two months preceding the election. On both occasions Labour ended up securing 40 per cent or more of the national vote. It is no coincidence that Labour kicked off their campaign grid last Monday with an NHS story, and we should expect to see a lot more of them over the final three weeks.

So what are the implications?
The NHS is the second most important issue that most regularly cited by voters, but at 36 per cent it is at a lower level than at any equivalent period except 2010 (Mar 2010, 22 per cent). The NHS has dropped by 25 per cent in importance since the equivalent point before the 2017 election.

For the government’s campaign these findings show the need to tread a fine line between defending their NHS record and overplaying their hand. For the opposition they show that there is a long, hard and direct slog needed to drag the salience of the NHS upwards. And, of course, for both there is the risk of events during a winter election derailing their health messages. Either way, expect more shooting for NHS goals in the days to come.

Richard Sloggett is a senior fellow at Policy Exchange and a former special adviser to Matt Hancock as health secretary

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